Standards development is at the heart of healthcare reform, according to David Blumenthal, MD, National Coordinator for Health Information Technology.

"Congress may not know it or realize it, but you all are very much at the center" of making health reform happen, he told members of the HIT Standards Committee during a Wednesday workshop. "Health infrastructure is assumed will be present and functioning when needed. That is a very, very tall order and one we are committed to doing our best to put into place."

Blumenthal said the National Health Information Network, designed to allow providers to share information for the efficient care of patients, is in the spotlight as Congress moves forward with health reform legislation. President Barack Obama has pledged $50 billion toward healthcare IT advancement over the next five years, with $20 billion already committed under the American Recovery and Reinvestment Act of 2009(ARRA), passed in February.

Congress is calling for an open-source resource for providers to establish interoperability under the NHIN, Blumenthal said. "This is a public resource, whose broadest use is our goal," he added.

He said the NHIN has developed a reputation of being a project of only a select group of interests and large private providers – who are often pioneers of healthcare IT. The goal has always been not to develop a closed network, he said, but a resource in the form of standards and specifications in the public domain.

"Because of how this idea was put into demonstration, that wide goal has sometimes been less evident," Blumenthal said. "We would like to reiterate that we view this as a resource to anyone who wishes to exchange information quickly, efficiently, privately and securely."

As "meaningful use" is defined and with the inclusion of information exchange, he said, the HIT Standards Committee will need to accelerate the availability of standards and specifications to bring them into faster and more effective use.

"I don't expect all of you to have answers today, but we will be thinking about this over next few months to bring this mission closer to a reality," he said.

John Halamka, MD, the committee's vice chairman, said the meeting is about "the evolution of our work and plotting the next six months of work."

There has been some adoption of products and some movement in the industry, "but if we are going to get every provider to be part of it, how do we ensure a glide path?" he asked.

Halamka, who is chairman of the Healthcare Information Technology Standards Panel, said the development of standards has taken several tracks as federal advisory panels at first aimed to make "large cookbooks" of how providers could apply specific use cases for interoperability. Now, under ARRA, standards developers are scaling back the use cases into more simple "reusable parts," with hopes they will be less daunting to a potential user, he said.

But with so many reusable parts, he said, providers are wishing they had a "thick cookbook" again.

"This is an interesting challenge," he said. "As we look at achieving the vision, how do we make it straightforward for people to join in?"

Halamka said there is a fine line between being too prescriptive with standards to the point of snuffing out innovation and optionality.